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Having An Egg Allergy Is No Longer An Excuse To Skip Getting A Flu Shot

BY: Rita Rubin, Forbes Magazine

Allergists are now promoting a “don’t ask, don’t tell” policy when it comes to egg allergies and flu shots.

If you’ve ever received a flu shot, and I hope you have, the health-care provider probably asked you whether you have an egg allergy or handed you a screening and consent form with that question.

Until relatively recently, if you answered in the affirmative, you wouldn’t be given a flu shot. That’s because most influenza vaccines are grown in chicken eggs and might contain a tiny amount of egg protein. Although there wasn’t any evidence that influenza vaccine could trigger an allergic reaction in people with egg allergies, the thinking was that it was better to be safe than sorry, so egg-allergic individuals were instructed not to get immunized against the flu.

But recent studies have shown that even having a severe egg allergy is no longer a reason to avoid getting vaccinated against the flu, so the American College of Allergy, Asthma & Immunology, in an updated "practice parameter" out Tuesday, says it's no longer necessary to bother asking about egg allergy before administering influenza vaccine.

"There really is no reason for providers or screening questionnaires to ask whether someone is allergic to eggs before they get a flu shot," Dr. John Kelso, a coauthor of the allergists' newly updated practice guideline, told me.

The latest practice guideline from the American College of Allergy, Asthma & Immunology opens the door to individuals with egg allergies getting immunized against the flu by a pharmacist in a drugstore or a supermarket, instead of having to go to a doctor's office in case they experienced an allergic reaction to the miniscule amount of egg protein in influenza vaccine. (Photographer: Christopher Dilts/Bloomberg)

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices (ACIP) last flu season updated its egg allergy guidelines and reiterated them for the current flu season. ACIP said anyone with an egg allergy can receive any age-appropriate flu vaccine. However, ACIP went on to say that people who've experienced a more serious reaction to eggs than hives--difficulty breathing, lightheadedness or vomiting--should get vaccinated in a medical setting, such as a doctor's office or a clinic, so that they can be monitored by a health-care professional capable of recognizing and managing severe allergic conditions.

In October, though, the American Academy of Pediatrics, in its recommendations for the current flu season, noted that "all children with an egg allergy of any severity can receive an influenza vaccine without any additional precautions beyond those recommended for any vaccine."

There are two non-egg-based influenza vaccines, but one isn't approved for children under 4 and the other isn't approved for anyone under age 18, according to the allergists' practice parameter, published by the Annals of Allergy, Asthma and Immunology. But their manufacturers avoided using eggs not because of allergy concerns but because they wanted to be able to produce influenza vaccine more quickly, Kelso said.

Research has shown that the amount of egg protein in a dose of influenza vaccine is less than 1 microgram. A microgram is one-millionth of a gram, or, if you’re not into the metric system, 28,349,523.125 micrograms equal one ounce. In other words, the amount of egg protein in a dose of influenza vaccine is so teeny that, as the allergists say in their practice parameter, “it’s highly unlikely to cause reactions even in the most severely egg allergic recipients.”

The newly updated practice parameter, published by the Annals of Allergy, Asthma and Immunology, removes the last vestiges of obstacles to getting immunized against thea flu for people with egg allergies. Or for people who think they have egg allergies. Up to 2% of children are allergic to eggs, but virtually all of them outgrow it by first or second grade, said Kelso, a faculty member in the Division of Allergy, Asthma and Immunology at the Scripps Clinic in San Diego.

And yet, some adults still think they’re allergic to eggs and avoid them as well as flu shots. “The term allergy is used very broadly,” Kelso noted. In other words, some adults might think they’re allergic to eggs when the real reason they don’t feel so hot after finishing off a big plate of huevos rancheros is indigestion.

The risk of not getting a flu shot is far greater than the risk of getting one, Kelso and his coauthors note. (FluMist, the nasal vaccine approved for people 2-49 years old, contains even less egg protein per dose than flu shots. It, too, is safe for individuals with egg allergies, according to the allergists. However, for the current flu season and the last, ACIP recommended against using FluMist because of concrerns about its efficacy in children and teens, and the vaccine's website still says it should not be given to people with severe egg allergies.)

Nearly a third of children with an egg allergy also have asthma, the practice parameter authors wrote, so they might be at a higher risk for flu-related complications. During the 2015-2016 flu season, they noted, more than 15,000 U.S. children younger than 5 years old were hospitalized because of the flu, and an estimated 124 U.S. children die of influenza each year.

Original article: https://www.forbes.com/sites/ritarubin/2017/12/19/having-an-egg-allergy-is-no-longer-an-excuse-to-skip-getting-a-flu-shot/#1c9ae20e39f3